Telestroke opens new means of treatment for stroke patients

Thursday, November 21, 2013

Neurologists do not have to be on site to provide consultation

WellSpan Gettysburg Hospital emergency department physician and medical director Bill Steinour and Betty Hutchison, RN, clinical educator, use the Telestroke technology during a simulation for a video consultation with a WellSpan neurologist. The technology consists of a sophisticated computer system, a webcam with a high-resolution camera and a high-definition monitor.

A technological advance is allowing WellSpan to serve new communities while enhancing care for stroke patients in York and Adams counties.

With the recently installed Telestroke technology, WellSpan Gettysburg Hospital as well as Chambersburg Hospital and Waynesboro Hospital, which are part of Summit Health, can initiate video consultation directly with a remote-based WellSpan neurologist.

The neurologist can see the patient, and the patient can speak directly to the neurologist using this technology.

The faster a patient receives proper treatment for a stroke, the better chances for recovery.

One form of treatment is to administer tPA, a clot-busting drug that can greatly reduce the disability resulting from a stroke for a very limited number of qualifying patients.

The drug, however, must be administered within 4.5 hours of symptom onset.

Unfortunately, not all hospitals have access to neurology specialists on site, so emergency department physicians at smaller hospitals have to consult a neurologist via phone. Telestroke technology, however, has changed that.

Telestroke consists of a sophisticated computer system, a webcam with a high-resolution camera and a high-definition monitor.

For neurologists, the ability to access patients is critical.

WellSpan neurologists are on-call to provide this service 24 hours a day, seven days a week. They can respond from the hospital or from their home, which is also equipped with Telestroke technology.

When a patient presents at WellSpan Gettysburg Hospital, Chambersburg Hospital or Waynesboro Hospital with a stroke, the emergency department physician calls the WellSpan neurologist on-call.

The Telestroke equipment is wheeled into the treatment room. The neurologist can zoom the camera in on the patient, conduct an assessment and an exam and talk to the patient, ED physician and family members.

Then after reviewing a CT scan of the brain and the patient’s history, the neurologist recommends treatment.

“The Telestroke technology is better than I ever expected,” said Vivian Faircloth, M.D., of WellSpan Neurology.

“I’ve been pleasantly surprised. The clarity of the images is amazing. You can even see the patient’s individual eyelashes.” She added, “It’s as close to actually being in the room with a patient as you can get.”

In the past, a neurologist’s consultation with the ED physician was strictly by phone until the neurologist arrived at the ED, which delayed the implementation of the treatment. Telestroke enhances the neurologist’s ability to hear first-hand from the patient and family members. It helps to minimize interpretation. Faircloth said being able to rapidly access stroke patients is key because “time is brain.”

Charles Marley, D.O., vice president of medical affairs, WellSpan Gettysburg Hospital, said, “Telestroke increases our access to specialists we wouldn’t have otherwise. It allows us to keep some patients at WellSpan Gettysburg Hospital that we wouldn’t have before,” he said. “In the past, all patients who needed thrombolic care were always transferred to WellSpan York Hospital. And, sometimes it was unnecessary. That’s hard on patients and family members.”

Lori Clark, vice president of neurosciences, said for selected patients, tPA is the number one treatment for stroke, and when it’s given in conjunction with a Telestroke consultation it’s as effective as being given in a stroke center.

“This is a very exciting development for our physicians and patients,” she stressed .

Marley said Telestroke use could expand to critical care consults in early 2014.

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